The Knowledge Egg

Øystein Eiring, Geir Kristian Lund, Endre Aas. Innovation group and project management, EviCare, Norway.

1. The problem 2. Making a solution 3. The Egg

The problem

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Clinicians need knowledge from research, but:

Problem 1: Most research findings are not reliable

2: Most research is not readable at point-of-care

Problem 3: Most reseach is not relevant

02/15/10 3

Evidence-based practice the heroic way

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Evidence-based practice the heroic way

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Evidence-based practice the heroic way

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Are there short-cuts to evidence-based

practice?

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Building a solution

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February 15, 2010 9

Shortcut # 1: Pre-appraised single studies

2. Knowledge refinery: – Reading the 130

best journals– Throwing 90

percent +– 7000 clinicians

asked for relevance

23 000 pre-appraised studies: MacPLUS

February 15, 2010 10

Shortcut # 1: Pre-appraised single studies

2. Knowledge refinery: – Reading the 130

best journals– Throwing 90

percent +– 7000 clinicians

asked for relevance

23 000 pre-appraised studies: MacPLUS

Problem:

will miss other studies about the same topic

Shortcut # 2: systematic reviews

Identifies all research about an intervention

Assesses quality of research and throws most

Summarizes the rest

Systematic reviews are more reliable than single studies

Shortcut # 2: systematic reviews

Identifies all research about an intervention

Assesses quality of research and throws most

Summarizes the rest

Systematic reviews are more reliable than single studies

Problem:

covers few topics and most often not conclusive

Shortcut # 3: clinical guidelines

Research only describes what is

Guidelines describe what should be done

Shortcut # 3: clinical guidelines

Research only describes what is

Guidelines describe what should be done

take into account values, resources, politics, patients opinions, expert opinion

Need quality assessment

Problem:

too lenghty to be useful at point of care

Shortcut # 3: clinical guidelines

Research only describes what is

Guidelines describe what should be done

take into account values, resources, politics, patients opinions, expert opinion

Need quality assessment

Shortcut # 4: evidence-based textbooks

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Shortcut # 4: evidence-based textbooks

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Problem:

lack local adaptation and ownership

Shortcut # 5: Evidence-based procedures

…care pathways

…care plans

…order sets

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Building a solution

What if we combined all the short-cuts

in a hierarchy?

(some are better than others)

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The 6S Model

Quality-assessed single studies

Systematic reviews

Quality-assessed systematic reviews

Single studies that need quality assessment

Guidelines and evidence-based textbooks

Localprotocols,pathwaysin CDSS

Seek answers

as close to the top

as possible

Quality-assessed single studies

Systematic reviews

Quality-assessed systematic reviews

Single studies that need quality assessment

Guidelines and evidence-based textbooks

Localprotocols, pathwaysin CDSS

More reliable,

relevant and

readable

Building a solution: full-text access

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Norwegian Health Library: core features

Publicly funded

Access for the whole population preferred

Quality assessments of knowledge -AGREE

6S increasingly used as fundamental knowledge model

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Scientific journals

Bibliographic databases

Evidence-bases textbooks

Clinical guidelines

Systematic reviews

What if we merged

the hierarchy

with full-text

local, national and international

knowledge resources?

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The Knowledge Egg

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The Knowledge Egg

Evidence-based local procedures/pathways

Evidence-based textbooks

Guidelines

Systematic reviews

Quality-assessed studies

Other studies

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One search into all resources

Instruction

Usage: by the individual clinician at point-of-care

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Here is the answer-in the top of the egg!

Usage: by those making procedures and pathways

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Benefits: –everything in your hand

Common interface for local, international and national knowledge

Continuous updating

Underlying machinery not visible

Decision support –not dictatorship

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Benefits: –everything in your hand

EBM despite low information literacy among health personnel

Shared knowledge between clinicians and patients

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Norwegian Electronic Health Library

Øystein Eiring, Geir Kristian Lund, Endre Aas. Innovation group and project management, EviCare, Norway.